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South Sudan: MSF Scales Up To Contain Cholera Outbreak

Miserable living conditions in displacement camps have provided an all-too welcoming environment for cholera.

May 23, 2014

More than 315 cholera cases have been recorded in South Sudan since the Ministry of Health (MoH) officially declared an outbreak in the capital, Juba, on May 15, 2014, and suspected cases elsewhere in the country are awaiting laboratory confirmation. Doctors Without Borders/Médecins Sans Frontières (MSF) immediately responded, organizing multiple donations of essential supplies to support MoH health facilities. In a race to help contain the outbreak, MSF’s emergency teams also began setting up a site for a cholera treatment center; looking at other locations where additional treatment centers could potentially be established; providing safe water; conducting awareness campaigns; and organizing cholera vaccinations in camps for displaced people (IDPs).

“Following five months of intense conflict, dire conditions in many camps for displaced people, and a worsening rainy season, we are concerned about the impact of the disease,” says Mr. Brian P. Moller, MSF Head of Mission in South Sudan. “Yet cholera can be simply and effectively treated if caught early enough. MSF’s priority is to ensure a quick and efficient response to contain the outbreak as much as possible, working on both the treatment of patients and the prevention of the disease.”

In Juba, MSF has been providing essential supplies to a number of small MoH clinics in the city, particularly the Juba Teaching Hospital, which is currently the only cholera treatment center. These donations included cholera beds, testing kits, chlorine solution, and oral rehydration salts (ORS). MSF also sent cholera-experienced clinicians and a water and sanitation expert to support hospital staff.

At the same time, MSF teams began constructing a 50-bed cholera treatment center (CTC) in Gudele district, one of the areas most affected by the outbreak. This CTC will be fully operational this weekend, with the capacity to expand to 100 beds, when necessary.

The organization also plans to open additional CTC’s in the capital to increase treatment capacity in the coming weeks. In the IDP camps in Juba, where MSF has been providing health care since December, emergency teams have already identified CTC sites in the event of outbreaks there and are also carrying out health promotion activities.

In the rest of the country, where suspected cases of cholera have been reported, MSF is responding in several states. In the camp for displaced people in Malakal, Upper Nile State, MSF pre-emptively set up a CTC, after vaccinating around 17,000 people there against cholera in April and May this year. In the same state, MSF sent an emergency team to Kaka, about 40 kilometers [24 miles] from Melut, to assess the situation in a local clinic, and to donate equipment and supplies. The organization is also preparing a contingency plan in Melut IDP camp in case of a cholera outbreak. In the displaced camp in Bentiu, Unity State, MSF is providing assistance to an ongoing cholera vaccination campaign and is prepositioning cholera related supplies.

In Lakes State, in Minkamman, where MSF has been providing assistance to an estimated 80,000 displaced people since December, the organization has carried out a supplementary cholera vaccination campaign in the camp. This campaign is targeting displaced people who may have missed previous vaccine rounds conducted earlier this year, because two rounds of the vaccine are necessary for it to work effectively. It will not protect 100 percent of those who take even both rounds, but it is, however, one of the few available methods of protecting communities from the widespread damage cholera outbreaks can do if no preventative measures are taken. Improving living conditions, and the water supply and sanitation in particular, is the other most effective option; to that end, MSF is also providing 500,000 liters of chlorinated water per day on this site, which is key to reduce the transmission of the disease. The teams on the ground are ready to set up a 20-bed isolation ward and a CTC in case of an outbreak.

Cholera is an acute intestinal infection caused by the bacteria Vibrio cholera, which is found in unsanitary environments. The diarrhea and vomiting brought on by the disease quickly lead to severe dehydration and can result in death. Cholera can be simply and effectively treated provided the treatment is started early enough. Treatment involves replacing the lost water and electrolytes such as potassium and sodium by rehydrating the patient with oral rehydration solution or, for the more serious cases, intravenously.

MSF in South Sudan: MSF has been providing medical humanitarian assistance in what is now South Sudan for over 30 years. After fighting broke out in Juba last December and then spread to several other states, MSF increased its capacity to rapidly respond to emergency medical needs in the country.

In the first five months of the crisis, MSF teams carried out more than 270,000 outpatient consultations, of which more than 110,000 were with children under the age of five. MSF also conducted almost 11,000 inpatient consultations, close to 6,500 of which were for children under five years. In addition, MSF teams conducted more than 2,000 major surgeries; treated over 2,300 people for war-wounds and assisted almost 6,400 infant deliveries.

MSF medical teams now work in 22 projects in 9 of the 10 states in South Sudan, providing basic healthcare, nutritional support, surgery, vaccinations, and water and sanitation support.